Hesperian Health Guides
Chapter 67: Artificial Legs
Artificial legs can be (and often are) made at home or in village shops. How well they work and how natural they look depend on many things, including costs, skills, and materials available.
The most common leg amputation is below the knee. A leg that has been amputated halfway between the knee and ankle works best for walking with an artificial limb. Here are some examples of artificial limbs, from simple to more complex.
- 1 WITH THE KNEE BENT
- 2 WITH THE KNEE STRAIGHT
- 3 Positions for FITTING A LIMB
- 4 Exercises to strengthen and straighten the leg
- 5 How soon can an artificial limb be fitted?
- 6 Temporary limbs—when to use them and why
- 7 Preparing the stump
WITH THE KNEE BENT
|HAND-HELD POLE LEGS||‘SAWED-OFF CRUTCH’ LEG|
plastic or wood leg support
canvas or leather sling for knee
leather or canvas bands
block of wood or piece of plastic curved to fit leg
WITH THE KNEE STRAIGHT
|BAMBOO AND PLASTER LEG||PLASTIC PIPE LEG WITH FOOT|
plastic pipe (PVC)
These limbs are better because the knee has full range of motion. Walking is easier and more natural. However, the person’s weight must be supported evenly over the entire stump, not only at the end of the stump.
Positions for FITTING A LIMB
will only work with a bent-knee limb
knee does not straighten fully
knee straightens completely
Exercises to strengthen and straighten the leg
From the time a leg has been amputated until a limb is fitted, daily exercises are needed to keep the hip and knee muscles strong and to avoid contractures. If weakness and contractures already exist, these should be corrected as much as possible before a limb is fitted. Exercises are discussed in "Prevention of Contractures".
How soon can an artificial limb be fitted?
Children born without a foot or part of a leg (or legs) can be fitted with an artificial limb as early as 10 or 12 months of age.
A child whose foot has been cut off can and should be fitted with a temporary limb as soon as the wound has healed. However, be very careful not to injure or put any pressure on the new scars or end of the stump.
Note: On a very young or fat child, it may be difficult to fasten the limb firmly to the knee (the bones may not stick out enough). Straps to a waistband and even over the shoulder may be needed.
Temporary limbs—when to use them and why
Because a stump usually shrinks and changes shape in the first weeks after a limb is fitted, it is often wise first to fit a low-cost, temporary limb. This is especially true if the amputation is new or the stump is swollen. A better-looking, more permanent limb can be made after 4 to 6 weeks, or when swelling is gone.
Preparing the stump
In the first weeks or months after an amputation, the stump tends to swell up. The swelling may in time lead to a club-shaped, deformed stump, which is difficult to fit with an artificial limb. For this reason, it is important to wrap the stump with elastic bandage from the time the leg is cut off until a limb is fitted, or at least until there is no more sign of swelling. Instructions for wrapping the stump are in "Care of the Amputated Limb".
|BAD SHAPE||If the stump is swollen or badly shaped, before fitting a limb, wrap it for several days (or weeks) to reduce swelling and improve shape.||
Wrap it to above the knee.
Note: When the person is not wearing the artificial leg, he should also wear an elastic bandage to control the stump shape
Before starting to make an artificial limb, STUDY THE PERSON’S LEG.
A good fit of the socket on the stump and at the knee is one of the most important —and difficult—parts of limb making. It helps to have an understanding of the bones and muscles in the leg.
Avoid pressure on bony bumps.
Put pressure on kneecap tendon.
Put pressure on muscle areas.
Avoid pressure on shin bone.
A GOOD SOCKET,
does not press on bony bumps just under the skin.
presses on against muscles
presses in firmly just below the kneecap. (The main weight bearing is here.)
does not press over shin bone.
|leaves enough space at stump tip so that tip will not be injured if the stump settles a little deeper into the socket.|
Before beginning, study the person’s knee and stump carefully. Note the positions of the kneecap, the bony bumps on the sides of the knee, and the shin bone.
|distance around knee just below kneecap and every 5 cm. around the stump||length from mid-knee to bone end||length from mid-knee to bone end||
length of foot
length from mid-knee to heel of good leg
Note: For the plaster and bamboo limb, only lengthwise measurements are needed.
Note: The artificial limb should be the same length or just a little shorter than the other leg.